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Benefits of guided biopsy are clear only for focal lesions

Despite advances in imaging techniques and serological investigations percutaneous needle biopsy of the liver is still important in accurately diagnosing hepatic disease. The basic technique, described by Sherlock, has changed little over the past 50 years.1 It is simple, cheap, and relatively safe and can be carried out at the bedside. In the past few years, however, ultrasonography has been increasingly used to guide the biopsy needle. A recent large survey of consultant gastroenterologists showed that 1 in 8 always used ultrasonography guidance for biopsies.2 Some consultants now believe that ultrasonographically guided biopsies are so much safer that blind biopsy can no longer be defended. Before this policy is adopted uncritically, however, it is important to examine the current evidence concerning safety, diagnostic yield, and cost.

Percutaneous liver biopsy has a mortality of 0.01%-0.1%.3 4 Death is usually due to bleeding or to biliary peritonitis as a result of puncture from the gall bladder. The incidence …

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